Clinical Context and Detection of the Murmur of Advanced Aortic Stenosis

Objectives: Auscultation is an important clue to the presence of aortic stenosis (AS). We sought to assess the effect of symptom status, prior knowledge of diagnosis, and other patient factors on murmur detection. Methods: Patients with moderate-to-severe AS by echocardiography at a single center between June 2015 and June 2016 were included. Five consecutive patient encounters (inpatient and outpatient) within 12 months before the...

Provider Variation in Antibiotic Prescribing and Outcomes of Respiratory Tract Infections

Objectives: Inappropriate antibiotic use for respiratory tract infection (RTI) is an ongoing problem linked to the emergence of drug resistance and other adverse effects. Less is known about the prescribing practices of individual physicians or the impact of physician prescribing habits on patient outcomes. We studied the prescribing practices of providers for acute RTIs in an integrated health system, identified patient factors associated with...

Single-Center Retrospective Study of Risk Factors and Predictive Value of Framingham Risk Score of Patients with ST Elevation Myocardial Infarction

Objectives: The objective of this study was to identify risk factors and clinical profile of the patients presenting with ST elevation myocardial infarction (STEMI). We further evaluated the utility of the Framingham Risk Score (FRS) in the accurate identification of these patients if used before their coronary event. Methods: We evaluated the demographic, clinical, and angiographic characteristics of patients admitted with STEMI. We also...

Diverticular Disease: The Old, the New, and the Ever-Changing View

Our understanding of diverticular disease has evolved significantly during the last 25 years, and as such, a reexamination is in order. We performed a literature search for the years 1960–2017 of PubMed, Medline, and Google Scholar for updates regarding the epidemiology, risk factors, and therapies for traditional diverticulitis as well as the recently described subtypes of diverticular disease, segmental colitis associated with...

Endobronchial Lesions in Patients Presenting with Hemoptysis

Objectives: The aim of this study was to determine the incidence of endobronchial lesions in patients presenting with hemoptysis. We also aimed to characterize features that would predict whether bronchoscopy would be useful. Methods: A retrospective chart review was conducted on 185 consecutive patients who presented with hemoptysis from January 1, 2006 to December 31, 2015 at Methodist Le Bonheur Healthcare–affiliated hospitals in...

Prevalence of HCV Infection in Adults with Congenital Heart Disease and Treatment with Direct Antiviral Agents

Objectives: Hepatitis C virus (HCV) infection affects >3% of the US population, which over time can lead to cirrhosis and hepatocellular carcinoma. The lack of a reliable screening method for HCV before 1992 resulted in a higher prevalence of the virus in adults with congenital heart disease who underwent corrective surgery that required blood transfusions. Direct-acting antiviral agents such as sofosbuvir/ledipasvir have significantly...

Commentary on “Prevalence of HCV Infection in Adults with Congenital Heart Disease and Treatment with Direct Antiviral Agents”

Advances in heart surgery in the past 50 years have provided a high level of survival in children born with congenital heart defects. The estimated number of adults living with repaired, unrepaired, or as-yet-unrecognized congenital heart defects exceeds 1.4...

Association of Anemia with Outcomes of Acute Heart Failure

Objectives: Anemia is common in patients presenting with acute congestive heart failure (CHF); when hemoglobin (HGB) declines to low levels, it can result in worse outcomes. The aim of this study was to determine a level of HGB on admission or discharge that affects outcomes in patients with CHF and then to evaluate the effect of the low HGB levels on these outcomes. Methods: We conducted a retrospective cohort study of 756 patients admitted...

Vision Screening in Adults Across the Life Span

Vision screening is quick, inexpensive, and easily performed by ancillary staff, and it may provide the physician with useful additional information for treatment...

History of Music Therapy and Its Contemporary Applications in Cardiovascular Diseases

Contrary to what is commonly believed, music therapy is an old cure, the use of which is lost in the mists of time. Music always has been perceived to have particular healing powers, and the entire history of civilization contains aspects that link music to physical and mental healing. It seems that the adoption of music for therapeutic purposes harks back to a distant past, probably since the Paleolithic period: it was believed that listening...

Measuring Adherence to Hepatitis C Direct-Acting Antiviral Medications: Using the VAS in an HCV Treatment Clinic

Objectives: To implement the widespread treatment of hepatitis C virus (HCV), validated self-report measures to assess medication adherence are needed for monitoring patients who are prescribed HCV direct-acting antivirals (DAAs). The Visual Analog Scale (VAS) is an efficient and well-validated tool for measuring adherence to antiretrovirals in human immunodeficiency virus populations. This study compared VAS scores with pill counts and serum...

Eradication Rate of Helicobacter pylori on the US–Mexico Border Using the Urea Breath Test

Objectives: Helicobacter pylori is prevalent worldwide, especially in Latin America. Triple and quadruple antibiotic therapies have been relatively effective; however, resistance has emerged in recent years. The treatment success rate of these regimens on the border of the United States and Mexico is unknown. Our study attempted to determine eradication rates of two major regimens based on urea breath test (UBT) results in patients previously...

A Brief Drug Class Review: Considerations for Statin Use, Toxicity, and Drug Interactions

Abstract: For approximately 30 years, statins have been effectively used to control cholesterol, thereby reducing the morbidity and mortality associated with cardiovascular disease. Evidence-based recommendations regarding how these drugs are dosed and used have changed significantly through the years. There are seven statins approved for use in the United States, and although the mechanism of action pertaining to cholesterol reduction is the...

E-Cigarette Toxicity?

Abstract: Tobacco smoking is the most preventable cause of morbidity and mortality. In just a few short years, electronic cigarettes (e-cigarettes) have become increasingly popular, especially for younger individuals. Many people believe that e-cigarettes are safe. The inhaled aerosols of e-cigarettes contain numerous potential toxicities, some of which could be dangerous for health with long-term use. The safety of prolonged aerosol exposure is...

Development of Multiple Primary Cancers in Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations of Kentucky

Objectives: The aim of this study was to investigate whether patients with lung cancer in Appalachian Kentucky are more likely to develop multiple primary cancers than patients in non-Appalachian Kentucky. Additional analyses were conducted to identify other factors that may be associated with an increased hazard of developing multiple primary cancers in patients with lung cancer. Methods: The data for this retrospective, population-based...

Radiologists’ Recommendations for Additional Imaging on Inpatient CT Studies: Do Referring Physicians Follow Them?

Objectives: Studies have found that recommendations for additional imaging (RAI) accompany up to 31% of index computed tomography (CT) scans. In this study we assessed the frequency with which recommendations are accepted by the referring physician and the impact of AI on case management. Methods: We performed a cross-sectional study of all index CT scans of the chest, abdomen, and pelvis performed on adult inpatients during a 1-month period...

Authors’ Response

To the Editor: The authors thank Dr Madias for his interest in our work. We discussed the possibility of takotsubo cardiomyopathy (TTC) and reverse TTC (rTTC) being a transient evolution of the same disease, given multiple reports in the literature of patients displaying temporal changes of akinetic areas during TTC with varying timelines....

Red Cell Width: An Emerging and Novel Biomarker of Systemic Inflammation

To the Editor: Systemic inflammation has been implicated in the etiology of many diseases and is often linked to poor health outcomes. Several indices have been used as markers for such inflammation....

Using Pill Identification Calls to Poison Centers as a Marker of Drug Abuse at Three Texas Military Bases

Objectives: Opioid abuse is a growing problem in civilian communities, and it has developed in the military as well. Telephone calls to poison centers requesting pill identification (ID) is a marker of drug abuse. This study identifies the number of pill ID calls made to the poison centers from areas containing and surrounding three Texas military bases during an 8-year period. Methods: We performed a retrospective observational study...

Acute Pancreatitis: Etiology, Pathology, Diagnosis, and Treatment

Acute pancreatitis is a fascinating disease. In the United States, the two most common etiologies of acute pancreatitis are gallstones and excessive alcohol consumption. The diagnosis of acute pancreatitis is made with a combination of history, physical examination, computed tomography scan, and laboratory evaluation. Differentiating patients who will have a benign course of their pancreatitis from patients who will have severe...